Hot Topics in IPC: January 25, 2023, COVID-19, CDC Shake-Up, and Bird Flu

Hot Topics in infection control and prevention.

COVID-19 Wrap-Up

The good news – COVID-19 cases continue to decline across the United States. The last 2 weeks have revealed a 30% decline in cases, with the daily average hovering around 45,000. Test positivity is also down, sitting at 12%, and across the board, other metrics like hospitalizations and even deaths have dropped. Most US states and territories are reporting double-digit drops in cases, except for a few: Illinois is showing a 76% increase in cases, Kentucky has a 49% increase, the US. Virgin Islands is up 187%, and Alaska is up 38%.

While we mostly feel confident in reporting that this winter season showed a much milder COVID-19 surge than previous winters, those cases, hospitalizations, and deaths were still avoidable and devastating. Consider a recent report that only 41% of US adults with impaired immune systems have received 4 doses of the mRNA vaccines. Even worse, less than 1% received the recommended 5 doses that was a part of guidance released in August 2022. The authors reported that “Participants 65 years and older were more likely to receive at least four vaccine doses than younger patients (hazard ratio [HR], 3.95 vs 2.52, respectively). Those least likely to receive at least four doses were Black versus White adults (HR, 0.77), patients who previously had COVID-19 vs never-infected participants (HR, 0.71), and those receiving high-dose corticosteroids versus patients not taking these medications (HR, 0.88).” These findings underscore the importance of a tailored and agile approach to COVID-19 vaccines and interventions. This might come to head with a new strategy that is being proposed by the US Food and Drug Administration (FDA). The agency is reportedly considering a new strategy for the national COVID-19 vaccine approach, which would adopting an annual update of the vaccine, similar to that of influenza shots. While the goal is to simplify the COVID-19 vaccine approach and move away from individuals having to remember how many shots they had and the time in between, many worry that this change could oversimplify the process and run the risk of reducing production capacity to respond to emerging strains.

CDC Changes – A Shake-Up to the Agency

We knew that changes to the Centers for Disease Control and Prevention (CDC) were imminent. Director Rochelle Walensky, MD, has reiterated failures of the agency during the COVID-19 pandemic and a need for a review and overhaul. This week it was released that several changes would occur, from merging of offices to a new reporting structure. Most of the CDC is now reportedly set to report to the Immediate Office of the Director, away from what was called a “Community of Practice structure.” It was reported that “The Center for Surveillance, Epidemiology and Laboratory Services and the Center for State, Tribal, Local and Territorial Support will be combined into a new agency entity called the National Center for State, Tribal, Local and Territorial Public Health Infrastructure and Workforce. The Center for Preparedness and Response will now be renamed the Office of Readiness and Response.” Even better, several new offices are being created to address health equity, public health data, surveillance, and technology. In efforts to modernize its approach to data and centralize leadership, the goal is to improve speed and efficiency. No agency is perfect, and the truth is that public health is difficult, often thankless work, that is often chronically underfunded. The CDC, like any agency, has been imperfect, and there were many times we found ourselves frustrated by their choices, communication strategies, and approach to this pandemic. Hopefully, these changes will lead to a more robust and agile agency that can effectively address health threats.

Something to Keep Your Eyes On…

A bird flu outbreak spreading in mink in a farm is causing concern – here’s why.